(1) Field of the Invention
This invention relates generally to the treatment of cancer and more particularly to vectors which replicate in neoplastic cells and which overexpress an adenovirus death protein (ADP) and to the use of these vectors in treating human cancer.
(2) Description of the Related Art
Cancer is a leading cause of death in the United States and elsewhere. Depending on the type of cancer, it is typically treated with surgery, chemotherapy, and/or radiation. These treatments often fail: surgery may not remove all the cancer; some cancers are resistant to chemotherapy and radiation therapy; and chemotherapy-resistant tumors frequently develop. New therapies are necessary, to be used alone or in combination with classical techniques.
One potential therapy under active investigation is treating tumors with recombinant viral vectors expressing anti-cancer therapeutic proteins. Adenovirus-based vectors contain several characteristics that make them conceptually appealing for use in treating cancer, as well as for therapy of genetic disorders. Adenoviruses (hereinafter used interchangeably with “Ads”) can easily be grown in culture to high titer stocks that are stable. They have a broad host range, replicating in most human cancer cell types. Their genome can be manipulated by site-directed mutation and insertion of foreign genes expressed from foreign promoters.
The adenovirion consists of a DNA-protein core within a protein capsid (reviewed by Stewart et al., “Adenovirus structure by x-ray crystallography and electron microscopy.” in: The Molecular Repertoire of Adenoviruses, Doerfler, W. et al., (ed)., Springer-Verlag, Heidelberg, Germany, p. 25-38). Virions bind to a specific cellular receptor, are endocytosed, and the genome is extruded from endosomes and transported to the nucleus. The genome is a linear duplex DNA of about 36 kbp, encoding about 36 genes (FIG. 1A). In the nucleus, the “immediate early” E1A proteins are expressed initially, and these proteins induce expression of the “delayed early” proteins encoded by the E1B, E2, E3, and E4 transcription units (reviewed by Shenk, T. “Adenoviridae: the viruses and their replication” in: Fields Virology, Field, B. N. et al., Lippencott-Raven, Philadelphia, p. 2111-2148). E1A proteins also induce or repress cellular genes, resulting in stimulation of the cell cycle. About 23 early proteins function to usurp the cell and initiate viral DNA replication. Viral DNA replicates at about 7 h post-infection (p.i.), then late genes are expressed from the “major late” transcription unit. Major late mRNAs are synthesized from the common “major late promoter” by alternative pre-mRNA processing. Each late mRNA contains a common “tripartite leader” at its 5′-terminus (exons 1, 2, and 3 in FIG. 1), which allows for efficient translation of Ad late mRNAs. Cellular protein synthesis is shut off, and the cell becomes a factory for making viral proteins. Virions assemble in the nucleus at about 1 day p.i., and after 2-3 days the cell lyses and releases progeny virus. Cell lysis is mediated by the E3 11.6K protein, which has been renamed “adenovirus death protein” (ADP) (Tollefson et al., J. Virol. 70:2296-2306, 1996; Tollefson et al., Virol. 220:152-162, 1996). The term ADP as used herein in a generic sense refers collectively to ADP's from adenoviruses such as, e.g. Ad type 1 (Ad 1), Ad type 2 (Ad2), Ad type 5 (Ad5) or Ad type 6 (Ad6) all of which express homologous ADP's with a high degree of sequence similarity.
The Ad vectors being investigated for use in anti-cancer and gene therapy are based on recombinant Ad's that are either replication-defective or replication-competent. Typical replication-defective Ad vectors lack the E1A and E1B genes (collectively known as E1) and contain in their place an expression cassette consisting of a promoter and pre-mRNA processing signals which drive expression of a foreign gene. These vectors are unable to replicate because they lack the E1A genes required to induce Ad gene expression and DNA replication. In addition, the E3 genes are usually deleted because they are not essential for virus replication in cultured cells.
A number of investigators have constructed replication-defective Ad vectors expressing anti-cancer therapeutic proteins. Usually, these vectors have been tested by direct injection of human tumors growing in mouse models. Most commonly, these vectors express the thymidine kinase gene from herpes simplex virus, and the mice are treated with gancyclovir to kill cells transduced by the vector (see e.g., Felzmann et al., Gene Ther. 4:1322-1329, 1997). Another suicide gene therapy approach involves injecting tumors with a replication defective Ad vector expressing cytosine deaminase, followed by administration of 5-fluorocytosine (Topf et al., Gene Ther. 5::507-513, 1998). Investigators have also prepared and tested replication-defective Ad vectors expressing a cytokine-such as IL-2, IL-12, IL-6, tumor necrosis factor (TNF), type I interferons, or the co-stimulatory molecule B7-1 in the anticipation that the Ad-expressed cytokine will stimulate an immune response, including cytotoxic T-lymphocytes (CTL), against the tumor (Felzmann et al., supra; Putzer et al., Proc. Natl. Acad. Sci. USA 94:10889-10894, 1997). Other vectors express tumor antigens (e.g. melanoma MART1), proteins that de-regulate the cell cycle and induce apoptosis (p53, pRB, p21KiP1/WAF1, p16CDKN2, and even Ad E1A), and ribozymes. An Ad vector expressing FasL induces apoptosis and tumor regression of a mouse tumor (Arai et al., Proc. Natl. Acad. Sci. USA 94:13862-13867, 1997).
Despite these generally positive reports, it is recognized in the art that replication-defective Ad vectors have several characteristics that make them suboptimal for use in therapy. For example, production of replication-defective vectors requires that they be grown on a complementing cell line that provides the E1A proteins in trans. Such cell lines are fastidious, and generation of virus stocks is time-consuming and expensive. In addition, although many foreign proteins have been expressed from such vectors, the level of expression is low compared to Ad late proteins.
To address these problems, several groups have proposed using replication-competent Ad vectors for therapeutic use. Replication-competent vectors retain Ad genes essential for replication and thus do not require complementing cell lines to replicate. Replication-competent Ad vectors lyse cells as a natural part of the life cycle of the vector. Another advantage of replication-competent Ad vectors occurs when the vector is engineered to encode and express a foreign protein. Such vectors would be expected to greatly amplify synthesis of the encoded protein in vivo as the vector replicates. For use as anti-cancer agents, replication-competent viral vectors would theoretically also be advantageous in that they should replicate and spread throughout the tumor, not just in the initial infected cells as is the case with replication-defective vectors.
Wyeth Laboratories developed replication-competent Ad vectors for vaccination purposes, using vaccine strains of Ad serotypes 4, 7, and 5 (Lubeck et al., AIDS Res. Hum. Retroviruses 10:1443-1449, 1994). Foreign genes were inserted into the E3 region (with the E3 genes deleted) or into a site at the right end of the genome. Two foreign genes used were hepatitis B surface antigen and the HIV envelope protein. They obtained good expression in culture, and were able to raise antisera in animal models. Phase I human trials were ambiguous, and the project was mostly abandoned.
Onyx Pharmaceuticals recently reported on adenovirus-based anti-cancer vectors which are replication deficient in non-neoplastic cells but which exhibit a replication phenotype in neoplastic cells lacking functional p53 and/or retinoblastoma (pRB) tumor suppressor proteins (U.S. Pat. No. 5,677,178; Heise et al., Nature Med. 6:639-645, 1997; Bischoff et al., Science 274:373-376, 1996). This phenotype is reportedly accomplished by using recombinant adenoviruses containing a mutation in the E1B region that make the encoded E1B-55K protein incapable of binding to p53 and/or a mutation(s) in the E1A region which make the encoded E1A protein (p289R or p243R) incapable of binding to pRB and/or the cellular 300 kD polypeptide and/or the 107 kD polypeptide. E1B-55K has at least two independent functions: it binds and inactivates the tumor suppressor protein p53, and it is required for efficient transport of Ad mRNA from the nucleus. Because these E1B and E1A viral proteins are involved in forcing cells into S-phase, which is required for replication of adenovirus DNA, and because the p53 and pRB proteins block cell cycle progression, the recombinant adenovirus vectors described by Onyx should replicate in cells defective in p53 and/or pRB, which is the case for many cancer cells, but not in cells with wild-type p53 and/or pRB. Onyx has reported that replication of an adenovirus lacking E1B-55K, which is named ONYX-015, was restricted to p53-minus cancer cell lines (Bischoff et al., supra), and that ONYX-015 slowed the growth or caused regression of a p53-minus human tumor growing in nude mice (Heise et al., supra). Others have challenged the Onyx report claiming that replication of ONYX-015 is independent of p53 genotype and occurs efficiently in some primary cultured human cells (Harada and Berk, J. Virol 73:5333-5344, 1999). ONYX-015 does not replicate as well as wild-type adenovirus because E1B-55K is not available to facilitate viral mRNA transport from the nucleus. Also, ONYX-015 expresses less ADP than wild-type virus (see Example 1 below).
As an extension of the ONYX-015 concept, a replication-competent adenovirus vector was designed that has the gene for E1B-55K replaced with the herpes simplex virus thymidine kinase gene (Wilder et al., Gene Therapy 6:57-62, 1999). The group that constructed this vector reported that the combination of the vector plus gancyclovir showed a therapeutic effect on a human colon cancer in a nude mouse model (Wilder et al., Cancer Res. 59:410-413, 1999). However, this vector lacks the gene for ADP, and accordingly, the vector will lyse cells and spread from cell-to-cell less efficiently than an equivalent vector that expresses ADP. The gene for ADP is also lacking in another replication-competent adenovirus vector that has been described, in which a minimal enhancer/promoter of the human prostate specific antigen was inserted into the adenovirus E1A enhancer/promoter (Rodriguez et al., Cancer Res. 57:2559-2563, 1997).
Thus, there is a continuing need for vectors that replicate and spread efficiently in tumors but that can be modified such that they replicate poorly or not at all in normal tissue.